Study: Most Advanced Cancer Patients Don’t Understand Prognosis

There’s a good chance you or someone you know has faced cancer at some point. For most patients, the cancer is treatable, thanks to new advances in treatment and technology. Unfortunately, there will be about 600,000 deaths associated with cancer this year, according to the American Cancer Society. Some treatments simply aren’t aggressive or effective enough to eliminate cancer cells, regardless of their cause.

Some doctors may avoid certain treatments because they may be experimental or dangerous. Because some patients don’t fully understand their sickness and their options, they don’t ask about these other kinds of treatment options. Further, many patients didn’t fully understand the full nature of their terminal illness. In a recent study published in the The Journal of Clinical Oncology, only 5 percent of all terminal cancer patients completely understood their diagnosis.

How the Study Was Conducted

Researchers from Memorial Sloan Kettering Cancer Center, Cornell University and Weill Cornell Medicine interview about 180 patients regarding their illness. These patients were ones who had been given no more than 6 months to live by their oncologists. They asked questions regarding four different aspects of their prognosis:

Acknowledgement that their cancer was terminal

Recognizing that it was incurable

Knowing how advanced their cancer was

Understanding they had months to live, not years

When researchers asked patients about these different indicators, only nine of the patients completely understood their illness. Further, only 18 of the patients — about 10 percent — had recently discussed their prognosis and life expectancy with their oncologist. In fact, only 68 of the patients had reported past discussions at all. Another 68 patients said they had never once had a discussion of their prognosis or life expectancy with their oncologist.

Note: Adds up to more than 100 percent, figuring in patients who reported recent discussions, past discussions and a combination of recent and past discussions with their oncologist. Source: Journal of Clinical Oncology

Researchers found this alarming. When patients were not fully aware of their situations, they are unable to make informed decisions about their end-of-life care. While there is an art in delivering this kind of bad news, patients need to hope for the best, while also preparing for the worst. While is is a difficult conversation, it is the job of the oncologist to ensure their patients are doing both with a full understanding of what is to come with their advanced cancer.

Should Doctors Be Held Liable?

Cancer patients tend to fall into one of two categories: those who are ready to give up the fight, and those who find strength in their diagnosis. For those who are in the advanced stages of cancer and have very little hope of recovery, the best option is often to prepare themselves for the end of their lives. That includes finalizing a will, possibly moving home and other actions to be comfortable and ready for the end. If patients aren’t ready for the end of their lives, or are given false hope, it could cause psychological trauma to both the patient and their family.

In extreme cases, a prognosis may not be given because of a failure to diagnose. A doctor may assume a cancerous mole is benign, or diagnose lung cancer as COPD. Or, more likely, they may diagnose a terminal cancer as a treatable one. Chemotherapy, radiation and other cancer treatments are painful and exhausting. If they are administered under the erroneous thought that a patient’s cancer is treatable, the doctor could be causing undue pain and suffering. In both of these cases — mental and physical anguish caused by a doctor’s poor decisions — a medical malpractice suit may be brought.

For these reasons, it’s imperative that an oncologist give their full report to a patient, however unpleasant it is. In the same light, doctors must give their diagnosis and prognosis in language that is clear and unambiguous. A patient should fully understand what they are up against, what their treatment options are (if any) and how to prepare for the next stage in their life, no matter how short.

This study, while it did not offer solutions, did point out the startling reality that terminal patients simply aren’t given the full information they need to prepare for the end of their lives. It’s a serious problem that doctors from all fields, not just oncology, should be held responsible for what they tell their patients. In some cases, it could be the difference between comfort and confusion at the end. But for others, it could literally be the difference between life and death.

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